Interprofessional Team Collaboration In Health Care

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Global Journal of Medical Research: KInterdisciplinaryVolume 17 Issue 2 Version 1.0 Year 2017Type: Double Blind Peer Reviewed International Research JournalPublisher: Global Journals Inc. (USA)Online ISSN: 2249-4618 & Print ISSN: 0975-5888Interprofessional Team Collaboration in Health CareBy Bachchu Kailash KainiGreenwich School of Management, United KingdomIntroduction- Health care is a multifaceted activity which requires health care professionals towork together for the patient or service users in a collaborative way to deliver the desiredoutcome. Hospitals are complex organisations humming with activities of heterogeneous groupsof people such as doctors, nurses, paramedical and administrative staff, all working with acommon goal of providing health care to service users (Kaini 2005, p.1). Health careprofessionals work together in a collaborative manner in various forms. It involves complexinteractions between two or more members of different professional disciplines (Reel andHutchings, 2007, pp.137). In a basic form, health care professionals consult their patients orservice users and, each other as required, about the services needed by their service users. Inmore complex form of care, health care professionals work more closely, identifying together withservice users what care services are required, who provides them and what adjustments need tobe made to the health care plan and management. WHO (2010) asserts that ‘it is no longerenough for health workers to be professional, in the current global climate, health workers alsoneed to be interprofessional (WHO, 2010, pp.36).GJMR-K Classification: NLMC Code: W rictly as per the compliance and regulations of: 2017. Bachchu Kailash Kaini. This is a research/review paper, distributed under the terms of the Creative Commons AttributionNoncommercial 3.0 Unported License http://creative-commons.org/licenses/by-nc/3.0/), permitting all non-commercial use,distribution, and reproduction in any medium, provided the original work is properly cited.

Interprofessional Team Collaboration in HealthCareAuthor: PhD, Associate Lecturer in Greenwich School of Management,London. e-mail: bkkaini@gmail.comII. Interprofessional TeamInterprofessional involves joint working andinteractions between health care professionals. It is acollaborative working (Leathard, 2003) in which healthcare professionals share a common purpose ofdeveloping mutually negotiated goals (Payne, 2000)which are achieved through agreed care plans,management and procedures (Colyer, 2012). Forinterprofessional care to happen in practice, health careprofessionals pool their knowledge, skills and expertise(WHO, 2010) and make joint decisions based upon ssional Health Collaborative, 2010). Kane(1983) defines the term ‘interprofessional team’ ashaving a common objective, differential professionalcontributions and a system of communication.Interprofessional care is the processes forproviding the best health services to service users andhelped to achieve the optimal desired outcomes andservice users’ satisfaction. The Health Force Ontario 2017 Global Journals Inc. (US)Yearealth care is a multifaceted activity whichrequires health care professionals to worktogether for the patient or service users in acollaborative way to deliver the desired outcome.Hospitals are complex organisations humming withactivities of heterogeneous groups of people such asdoctors, nurses, paramedical and administrative staff, allworking with a common goal of providing health care toservice users (Kaini 2005, p.1). Health careprofessionals work together in a collaborative manner invarious forms. It involves complex interactions betweentwo or more members of different professionaldisciplines (Reel and Hutchings, 2007, pp.137). In abasic form, health care professionals consult theirpatients or service users and, each other as required,about the services needed by their service users. Inmore complex form of care, health care professionalswork more closely, identifying together with serviceusers what care services are required, who providesthem and what adjustments need to be made to thehealth care plan and management. WHO (2010) assertsthat ‘it is no longer enough for health workers to beprofessional, in the current global climate, healthworkers also need to be interprofessional (WHO, 2010,pp.36).WHO (2010) further states that the world isfacing a shortage of health workforce and policy makersare looking for new and innovative ways that can helpthem develop policies and programmes to bolster theglobal health workforce. Interprofessional teamcollaboration in health care is essential for thedevelopment of a collaborative practice friendly healthwork force, one in which all health care professionalswork together to provide all kinds of services in ahospital. Different health care professionals have theirown background, defined roles and responsibilities,code of practice and expertise. The objective of theirpresence in health care set up is only to offer the bestpossible service to alleviate or improve service users’health problem.It was felt that the interactions between healthcare professionals in the past have been limited.Concepts of specialities and sub-specialties areemerging in health care. Most of the service users areaware of their treatment and care plans due to easyaccess of clinical and health care information. Differenthealth care professionals such as nurses, doctors, biomedical scientists, radiographers, pathology techniciansetc are interdependent or associated to each other.Therefore, patient care in isolation is impossible.According to Parsell and Bligh (1999), the bordersclarifying the rules, roles and responsibilities of differenthealth care professionals are now less distinct due tothe increasing similarity of knowledge and skill.The range and complexity of factors thatinfluence health and well-being, diseases and illnessesrequire health care professionals from all specialties andgroups to work together in a comprehensive andcollaborative manner (Canadian Nursing Association,2005). For example, health service users needinformation about various health issues for preventionand treatment of diseases and illness, immunisation,screening for disease prevention, diagnosis of theirhealth problems, continuous support for behaviouralchange and monitoring of management plans for longterm health issues. Working together and collaborativelyin an interprofessional care team and the combinedknowledge, skills and expertise of health careprofessionals become a very strong tool to enhance thehealth of the entire population served (Canadian NursingAssociation, 2005).1Global Journal of Medical Research ( KD ) Volume XVII Issue II Version IHI. Introduction2017Bachchu Kailash Kaini

Interprofessional Team Collaboration in Health CareYear2017(2007) defines interprofessional care in its report‘Interprofessional Care: A Blueprint for Action in Ontario’and states that it is ‘the provision of comprehensivehealth services to patients by multiple health caregivers,who work collaboratively to deliver quality care withinand across settings’. The Health Force Ontario (2010)further states that interprofessional care is ‘acollaborative, team-based approach to providingoptimal patient care and it benefits and empowerspatients, and significantly improves health care providersatisfaction’.Global Journal of Medical Research ( KD ) Volume XVII Issue II Version I2III. Health Care ProfessionalsThe health care team is composed of a numberof professionals of different backgrounds, education,training, experiences and theoretical viewpoints. Theydiffer not only in the resources they bring to the team,but also in role expectations, status, and the extent oftheir legal responsibility for the service users (Duncanisand Golin, 1979). Among the professions oftenrepresented on the team are medicine, nursing, alliedhealth professions (AHPs) and health care managementprofessionals. Duncanis and Golin further assert thateach health care team is a unique blend of professionaland personal characteristics of its members, itseffectiveness determined largely by the dynamics of thatconfiguration.Moreover, different disciplines in health carehave different philosophies and different problemsolving styles. For the benefits of service users andhealth care professionals, they have to work on the teamstructure. Each health care team develops certain rulesof operation, certain ways of proceedings to accomplishits task. These may range from unwritten or informalgroup norms of behaviour to formal written proceduralmanuals (Duncanis and Golin, 1979). Drinka and Clark(2000) assert that there are various specialties in healthcare and different types of technical skills to be learntand knowledge to be acquired in health care. However,there are overlaps in some of the main bodies ofknowledge and skills that underline different healthprofessions. Collaboration is one of the characteristicsof the team and team members’ relationship dependson how they collaborate and who they work with.a) Roles and ResponsibilitiesProfessionalsofHealthCareRoles are associated with assigned tasks orbehaviour that is expected to be performed by anindividual or a team. Sullivan (1998) asserts thatresponsibilities refer to accepting accountability forviews expressed, and ultimately for the decisions made.Without defined roles and responsibilities, health careprofessionals cannot perform effectively and that maycreate chaos in the complex work environment in healthcare organisations. Duncanis and Golin (1979) state thatroles of team members are generally defined in terms of 2017 Global Journals Inc. (US)the particular professional competencies of each teammember and the nature of the task to be done. In healthcare professionals’ team, the roles that each memberplays may be clinical and may serve a group dynamicfunction in the team. Each team member is assignedspecific roles and responsibilities in the interprofessionalcare team.Hornby and Atkins (2000) define role as a partto be fulfilled or carried by a health care professional orgroup to achieve shared goal and desired outcomewhich is essential for interprofessional care andcollaboration between health care professionals. Rolesand responsibilities of health care professionals aredefined in their terms of contract and job description.They are bound to follow their professional norms,clinical practices, standards, organisational rprofessional Education Collaborative (2011) statesthat understanding of how professional roles andresponsibilities complement each other in health careorganisations are important part of their professional life.Julia and Thompson (1994) describe two kindsof team roles – task and maintenance roles. They furthermention that these two roles assumed by the membersare characterised to assess the degree to whichindividual participation either facilitates or hinders teamprocess; and the concept of role applied to teamprocess provides a way for team members to symbolisethe active participation of every other member in a team.Lister (1982) describes roles in the interprofessionalteam into personal roles and professional roles.Personal roles are based on the personality, socioeconomic and cultural factors whereas professionalroles derived from occupational status. Lister furtherstates that professionals may assume other teamfunction roles based on either professional or personalroles, further complicating the analysis of team rolefunction typically seen in team behaviour.It is expected that health care professionals arewell informed of their roles, responsibilities andprofessional boundaries, but in reality, this may notalways the case (Barrett and Keeping 2005).Overlapping roles and expertise, extended roles andcross-professional working practice are the factors thatmay shadow the clear definition of their roles. Forexample, roles of podiatry team and tissue viabilitynurse may be conflicting while offering services to apatient with heel pressure ulcers. Bliss et al (2000) statethat lack of clarity and misunderstanding regarding theboundaries of professional roles may be a factor inrestricting the utilisation of relevant professionals withininterprofessional practice. Overlapping and blurringprofessional roles in interprofessional care team canresult in feelings of insecurity and anxiety and canweaken professional confidence (Barrett and Keeping2005; Loxley 1997 and Booth and Hewison, 2002).Farrell et al (2001) study informal roles in team

2017 Global Journals Inc. (US)Yearacademic writings, teaching, tutorials, clinicalgovernance and risk management, policy formulationand reviews, evaluation, monitoring etc. Understandingof non clinical roles helps to overcome divisionsbetween health care professionals or different groups(Miller et al, 2001). Leathard (2003) asserts that healthcare professionals no longer enjoy the security ofstructured and defined traditional roles and changeshave been noted from ‘practice based training’ to‘university based education’ in nursing, therapy andsocial work.The nature and complexity of the health issue ofservice users define the roles and tasks in which agroup of health care professionals interacts andengages. A task for health care professionals can be anassessment, review, clinical judgement, intervention,clinical decision, referral, diagnosis, treatment or anyother health services performed by them in relation to aservice users’ health issue. The Canadian HealthServices Research Foundation (2006) states that thegreater the interdependency of health careprofessionals, the higher the level of collaborationrequired to perform their tasks and to achieve theoptimal desired outcomes. Miller et al (2001) assert thatthe role understanding is a complex issue as it consistsof understanding others’ roles, defining on how roles areachieved in daily job and understanding of the rationalebehind a professionals’ contribution.Health care professionals have a shared goal ofproviding good care to all service users. However, in thepractical scenario; the different roles, responsibilitiesand core values between health care professionalsmeans the issues arising in day-to-day practice mayvary (Reel and Hutchings, 2007, pp.144). Therefore, it isimportant to recognise and respect each other’s roles,responsibilities, opinions, expertise and work stresses.This is required to play an effective role of a member ofinterprofessional care team.Orchard et al (2005) suggest that members of ahealth care professional team should be aware of theirrole and expertise and they should be confident in theirown capabilities, recognise the professional boundariesof their scope of clinical practice, be committed to thevalues and ethics of their own profession and beknowledgeable of their own practice standards. TheHealth Professions Regulatory Networks (2008) assertsthat health care professionals must also be mmunications with other members of theinterprofessional health care team, and promote teamproblem solving, decision making and collaboration byapplying principles of group dynamics and borative(2011) asserts that health care team member’s rolesand responsibilities vary within legal boundaries andactual roles and responsibilities change depending on3Global Journal of Medical Research ( KD ) Volume XVII Issue II Version Idevelopment stages as described by Tuckman (1965) inhis team development model and conclude that informalrole differentiation is observed at the beginning stagesof team development and begins to diminish in the laterstage.Health care professionals and service usersdefine their roles for themselves and other teammembers based on their experience, learning and theneed of the services. Furthermore, they act within thedefined and agreed roles in health care organisationsand the society. Leiba (1994) states that health careprofessionals and service users must ensure flexibilityand willingness to modify or even exchange their rolesaccording to the needs of individual cases for effectiveinterprofessional care and collaborative practice. Theroles that a health care professional plays and the waypeople evaluate them in the society are important tomaintaining a good self image. Hornby and Atkins(2000) assert that the self image of health careprofessionals and the image created by the society havea very strong impact on interprofessional care andcollaboration.Miller et al (2001) state that if health careprofessionals have detailed and accurate knowledge ofother health care professionals’ roles and boundaries,they are able to assess service users need when it isappropriate to refer to another member of the team forfurther treatment or assessment. It is argued that healthcare professionals should remain flexible at theprofessional boundaries of their roles in order to developteam knowledge and skills. Therefore, the requirementfor health care professionals to be role flexible isfundamental to health service delivery.Hidden roles create misunderstanding ofprofessionals’ roles and responsibilities. It may be dueto lack of clarity of roles or unseen tasks that a healthcare professional is assigned to carry out. If health careprofessionals from two different teams or organisationswork together, there may be different policies, protocolsand practices in place. Such practices also createconfusion in clarifying health care professionals’ roles.Miller et al (2001) state that the differentiation of rolesand the way in which non task based roles can developare two factors to consider when examining the natureof other health care professionals’ role contribution.Health care professionals get an opportunity tounderstand the roles of other professionals by workingtogether in the close vicinity. Moreover, it makesinterprofessional care more collaborative as everyonecan easily engage in interaction and in-depthcommunication about specific issues and closeobservation of practices.Health care professionals have to play nonclinical roles in their day-to-day jobs. Non clinical rolesinclude business planning, administrative andmanagerial, service development and ing,2017Interprofessional Team Collaboration in Health Care

Year2017Interprofessional Team Collaboration in Health CareGlobal Journal of Medical Research ( KD ) Volume XVII Issue II Version I4the specific care situation and sometimes as specifiedin the terms of references of the job. Many times healthcare professionals cannot communicate their own roleand responsibilities to other colleagues properly. In sucha condition, they cannot communicate others what theydo, cannot understand what other professionals do andhow others can help them to deliver an effective healthservices.Health care professionals’ roles evolved overtime and it may be difficult to some health careprofessionals when other colleagues are taking on someof their roles and it may be relief for others as theircolleagues helping them to perform their tasks (Reeland Hutchings, 2007, pp. 147). Gorman (1998) statesthat roles in a high performing team can be fluid androles of health care professionals in an interprofessionalteam get passed back and forth, for example,leadership will shift from person to person as thecircumstances demand. Roles of health careprofessionals in hospitals are limited by legalrequirements and they have to exercise theirprofessional skills and expertise with due care anddiligence.b) Skills and CompetenceCollaborationforInterprofessionalHealth care professionals exposed in theoreticaland practical education, training and personaldevelopment during their education and career in theirown field and gain strong discipline based knowledge,skills and capability that give access to professionaljurisdictions. Therefore, other health care professionalgroups may have limited understanding of thecomplexity of relationships between them (D’Amour etal. 2005).Hornby and Atkins (2000) assert that relational,organising and assessment skills are main threecollaborative skills required for health care health careprofessionals. Relations skills are more about interactionand communication skills whereas organising skills arerequired for organising groups, meetings, setting uppatient referral systems etc. Assessment skills arerelated to collecting, analysing and reflecting inevidence. Hammick et al (2009) suggest the followingthree categories of basic competencies for being aninterprofessional practitioner.Knowledge Understand the role and working context of otherpractitioners.Recognise the range of knowledge and skills of allother colleagues.Understand the principles and practice of effectiveteamwork. 2017 Global Journals Inc. (US)Skills Apply sound verbal and written communicationmethods.Identify situations where collaboration is helpful oressential.Work collaboratively with service users and carers.Use interprofessional learning in work settings.Attitudes Acknowledge and respect others’ views, values andideas.(Hammick et al, 2009; pp. 23)Hammick and colleagues state that combiningthe knowledge, skills and attitudes enables a health careprofessional to be a competent practitioner. As healthcare professionals’ careers develop and they moveforward to more senior positions, their role require themto have more advanced interprofessional competencies.However, values for the interprofessional competenciessuch as respect for everyone, willingness to engage, acaring disposition towards colleagues and anappropriate attitude remain the same for all levels ofprofessionals (Hammick et al, 2009, pp;23)CHSRF (2006) asserts that integration of newhealth care professionals into clinical practice requiresan orientation on the knowledge, skills, and attitudesneeded for interprofessional care and teamwork,interactional factors and change management. A teamdevelopment guidance or strategy that focuses ondeveloping and sustaining capacity at the organisationaland work or local level is also vital for the integration ofhealth care teams into clinical practice.Interprofessional Education Collaborative (IPEC,2011) published an expert report -‘Core Competenciesfor Interprofessional Collaborative Practice: Report of anExpert Panel’ in 2011 and highlights the followingcompetencies for interprofessional collaboration: Values/Ethics for Interprofessional practice.Roles/responsibilities.Interprofessional communication.Teams and teamwork.Canadian Interprofessional Health Collaborative(CIHC, 2010) published ‘A National InterprofessionalCompetency Framework’ and mentions the following sixcompetency domains for collaborative practice: Interprofessional communication.Patient/client/family/community centred care.Role clarification.Team functioning.Collaborative leadership.Interprofessional conflict resolution.

c) Impact of Interprofessional CollaborationHealth services are designed to provide thebest possible care to service users and families, toimprove the quality of life, to alleviate health issues andimprove the health conditions. The main objective of IPCis to bring a broader scope of health care professionals’knowledge, skill and expertise to the efforts to improvethe quality of care and clinical outcomes related toservice users’ health problems and issues. The mainquestion of interprofessional collaboration is whetherinterprofessional care is benefiting patients, serviceusers, their families, health care professionals and thehealth system. Interprofessional collaboration comesinto practice to ensure that health care professionalscan complete a care task or combination of tasks thatthey could not achieve effectively on their own (Reeveset al, 2010). According to Schmitt (2001), the impact ofinterprofessional collaboration should be assessedacross the range of problems for which the health careteam has been formed and operated. Effective healthcare cannot be achieved in isolation. The health caredelivery system is based on a sequence of co-ordinatedactivities of professionals from various disciplines.According to Wanger (2004), it requires synchronisedand rigorous efforts from all health care professionalsand individuals and an appropriate care delivery system.Some authors and researchers suggest that theadvantages of effective interprofessional teamcollaboration can be significant. The outcome ofPromoting effective teamwork in health care in Canada:Policy Synthesis and Recommendations’ has alsorecommended interprofessional collaboration as aneffective way to reduce stress, burnout among healthcare professionals, to improve the quality of care andenhance patient safety.Various research findings have linked theoutcomes of interprofessional collaboration with mainlyservice users, health care professionals and health careorganisations or systems. The Health ProfessionsRegulatory Network (2008) highlights the followingoutcomes associated with collaborative practice forservice users, health care professionals and health careorganisations:Outcomes of collaborative practice for service users/patients: Improved patient satisfaction.Improved patient transfer and discharge decisions.Improved patient care and outcomes.Decreased risk-adjusted length of stay for patients.Reduced medication errors.Outcomes of collaborative practice for health careprofessionals: Improved job satisfaction.Decreased job associated stress.Lower nurse turnover rates.Improved communication among caregivers.Improved efficiency.Improved understanding of roles. 2017 Global Journals Inc. (US)Yeareffective interpersonal team collaboration is improvedand better patient care (Leathard, 2003; Payne, 2000;Overtveit et al, 1997; Miller et al, 2001; Hornby andAtkins, 2000). Some of the reasons forbetter patientoutcomes mentioned by those scholars are thatcollaborative practices and team approaches help teamfunction better and make appropriate decisions forservice users, co-ordinated and integrated action,capabilities to cope up with stressful and multifacetedenvironment, combined skills, knowledge and expertisefor dealing with complex health problems and teamsynergy.Barrere and Ellis (2002) confirm thatinterprofessional collaboration between doctors andnurses was a fundamental factor in positive patientoutcomes regardless of the severity of a patient’scondition. Weschules et al (2006) carried out a researchin primary care and hospital set up and confirmed thatimproved patient outcomes have been demonstrated instudies of collaboration between pharmacists andphysicians, and when pharmacists are included as partof the health care team. O’Brien-Pallas et al (2005) havealso gathered the evidence of the positive outcomes ofnurse-doctor collaboration in Canada. A report byOandasan et al (2006) ‘Teamwork in health care:5Global Journal of Medical Research ( KD ) Volume XVII Issue II Version IThese competencies focuses on the ability tointegrate knowledge, skills, attitudes and values inarriving clinical judgements rather than relying on thedemonstrated behaviours to demonstrate competence(CIHC, 2010). Engel (1994) highlights the ability to usean understanding of group dynamics, adapting standing of how the interaction and productivity ofthe team as a whole tends to change over time ration. Furthermore, Engel discusses managingself, managing with others, communication, negotiation,seeking and giving advice as other competencies for thesame.Health care professionals competencies gainedthrough academic qualifications, training or experiencemay be diminished unless these skills are usedfrequently or at least practised intermittently in simulatedsituations (Engel, 1994; pp.72). Therefore, it is theresponsibility of health care professionals, managersand leaders to arrange continuing professional andpersonal development to practice these skills andknowledge in different health care set ups. Hammick etal (2009) argue that health care professional understandthe values, knowledge and skills of others in the healthcare team so that everyone can contribute in aharmonised and better way.2017Interprofessional Team Collaboration in Health Care

Interprofessional Team Collaboration in Health CareOutcomes of collaborative practice for health careorganisations Decreased costsImproved efficiency of health care providers(The Health Professions Regulatory Network,2008; pp.3)Year2017IV. ConclusionGlobal Journal of Medical Research ( KD ) Volume XVII Issue II Version I6The main objective of interprofessional care isto deliver the most optimal public health services, whichrequires looking atproblems from various medical andnursing perspectives and, hence, to make compromises(Pecukonis, et al, 2008). In terms of employment healthcare is one of the biggest industries. There is aconsiderable pressure as high costs involved with anincreasing demand in an ageing society. In order to fulfilthe demands and to provide high-level public healthservices, the medical and nursing staff need to sharetheir learning and optimise their collaborative efforts. Asvarious professions have different norms and habitscollaboration is extremely vital for the delivery of efficienthealth services. Through collaborative practices, healthcare professionals are also able to learn from each otherand to discover more about themselves and othercolleagues. Sullivan (1998) asserts that health servicedelivery is an interactive process and requires coherentand aligned efforts to continuously review roles andresponsibilities of health care professionals.As health care workers professionals dedicatetheir time an

care professionals in the past have been limited. Concepts of specialities and sub-specialties are . (Canadian Interprofessional Health Collaborative, 2010). Kane (1983) defines the term 'interprofessional team' as . health care professionals, they have to work on the team structure. Each health care team develops certain rules

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